Healthcare In A Minute - March 2017

Affordable Care Act. A bill to replace the ACA, called the “American Healthcare Act”, has just passed the Ways and Means committee in the Republican controlled House. The bill would: eliminate many of the taxes that support expanded Medicaid and the premium subsidies on the exchanges and replace them with consumer tax credits, provide block grants to the states for Medicaid, and discontinue the individual mandate requiring all to have insurance or pay a penalty. The bill would continue, however, the basic cornerstones of the ACA: allow children to remain on a parent’s plan until age 26, no life time monetary caps on illnesses, and insurers cannot deny coverage for pre-existing conditions. Rather than going through a disruptive and highly political repeal and replace process, many industry observers wonder why the changes proposed in the new bill were not simply introduced in Congress, over the last six years, as amendments to the ACA. The insurance lobby (AHIP) has expressed approval of some of the changes, but it has expressed concern about the potential decline in coverage and the negative impact on our most vulnerable populations. The American Medical Association flat out will not support the new bill. The hospital lobby says the probable increase in the uninsured will cost hospitals billions. Washington observers and healthcare policy experts believe the bill, as written, will not garner enough support in the Senate. The Congressional Budget Office still has to determine if the new bill’s numbers add up. The CBO has estimated that 15 million people could lose their insurance.

Mega merger drama. Critics of the ACA have maintained many consumers really don’t have choices because one in three markets has only one insurance company left on the exchange. Consequently, consumers, physicians and hospitals could potentially be at the mercy of monopolistic pricing. Insurance companies maintain that mergers (resulting in less choices) will allow them to reduce costs and increase efficiencies which would benefit the consumer. The Department of Justice isn’t buying that has blocked the mega merger of Anthem and Cigna, the second and third largest commercial insurers in the nation. Incredibly, Cigna is now suing Anthem to end the merger agreement and for damages. Anthem has countersued. The AMA has expressed its strong concern over the possibility of politically driven settlement negotiations between Anthem and the DOJ that could result in Anthem closing the deal with Cigna.

Accountable Care Organizations. ACOs were established by the ACA to cut costs and improve access and quality. More than 850 ACOs across the country care for over 28 million people. Hospitals, physicians and insurers have been collaborating the past six years. The majority of ACOs participate in shared savings programs with Medicare and commercial insurers. Industry experts are confident ACOs will survive any changes in the laws of the land.

Telehealth. More and more insurance companies are paying for telehealth. The immediate benefits are easier access, enhanced doctor/patient communication and remote monitoring of incapacitated patients. It will take more time and experience to determine whether or not the increased utilization of physician services via telehealth is eventually outweighed by cost reductions in other areas like inpatient care and drug utilization. A study published in Health Affairs followed three years of claims for respiratory infections. The study concluded that nine of ten telehealth visits (for this condition) represented new or additional utilization versus visits that substituted for an in person encounter. The authors of the study recommended insurers or even providers might want to increase patient out of pocket costs to prevent frivolous or unnecessary telehealth utilization and that telehealth might have more of a positive impact for those patients with traditionally undertreated conditions like diabetes and mental health.

Obesity. In a study published in “Cell Metabolism”, researchers found that a dopamine deficit may be the major cause of physical inactivity which has often been blamed on obesity. Lab mice were divided into two groups. The first group was fed low fat food while the second received high fat food. The mice on the high fat diet naturally gained more weight, but researchers noted all ice were inactive, due to low dopamine levels, to start. So weight gain itself did not lead to inactivity in these mice.

Dementia. 46 million people worldwide suffer from some sort of dementia. In the US, 5 million people have Alzheimer’s disease. One in three seniors will die from dementia complications. Dementia costs us about $236 billion a year. Researchers at Boston University school of medicine found that people who sleep more than nine hours on average are TWICE as likely to develop dementia than those who sleep less than nine hours on average.

Social media. Social media (SM) is having more and more of an impact on consumers and their behaviors every year. 40% say information gleaned from SM affects how they deal with their health. 19% of smartphone owners have at least one health related app. 41% of us say SM influences our choice of providers and hospitals. 30% of healthcare professionals use SM for networking. When it comes to sharing health info via SM, 43% of us are comfortable sharing with hospitals, 47% with physicians, 38% with insurers and 32% with pharmacies. 60% of physicians report SM actually improves the quality of health in their patients.

Really? And finally this. “Nobody knew that healthcare could be so complicated”. President Donald Trump. February 27, 2017.